优化肠外营养以实现小于 1500 克出生体重的早产儿根据现行指南获得足够的体重增加：一项前瞻性观察研究。
Optimizing parenteral nutrition to achieve an adequate weight gain according to the current guidelines in preterm infants with birth weight less than 1500 g: a prospective observational study.
机构信息
Department of Pediatric Gastroenterology, Hepatology and Nutrition, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, 7 Wei Wu Road, Zhengzhou, 450003, Henan, China.
Department of Neonatology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, Henan, China.
出版信息
BMC Pediatr. 2021 Jul 7;21(1):303. doi: 10.1186/s12887-021-02782-1.
AIM
European Society for Clinical Nutrition and Metabolism released the guidelines on pediatric parenteral nutrition in 2018. We aimed to compare the parenteral nutrition (PN) regimen with the current guidelines, evaluate weight gain and explore the correlation of parenteral macronutrient and energy intakes with weight gain outcome in preterm infants with birth weight less than 1500 g.
METHODS
A prospective observational study was conducted. Parenteral macronutrients and energy intakes were described. Weight gain during PN was assessed. Nutritional factors associated with weight gain outcome after PN were identified using a cox proportional hazards model.
RESULTS
A total of 163 infants were included in this study, in which 41 were extremely low birth weight (ELBW) infants and 122 were very low birth weight (VLBW) infants. Average glucose, amino acid, lipid, and energy during the first postnatal week were 7.5 g/kg/d, 2.4 g/kg/d, 0.8 g/kg/d, 48 kcal/kg/d. Median maximum glucose, amino acid, lipid, and energy were 11.1 g/kg/d, 3.5 g/kg/d, 3 g/kg/d, 78 kcal/kg/d. Median days to maximum glucose, amino acid, lipid, and energy were 10, 9, 12, 11 days. The proportion of appropriate for gestational age (AGA) infants was 76.9%. The ratio of infants without poor weight gain outcome after PN was 38%. With every 0.1 g/kg/d decrease of maximum amino acid and average lipid during the first postnatal week, the probability of appropriate weight gain outcome decreased by 77.6 and 74.4% respectively. With each additional day to maximum glucose and energy, the probability of appropriate weight gain outcome decreased by 5.6 and 6.1% respectively.
CONCLUSIONS
Most preterm infants with birth weight less than 1500 g remain below the latest recommended nutrition goals. The poor weight gain outcome of these infants after PN is related to insufficient parenteral macronutrient and energy intakes. PN strategies should be improved according to the latest evidence-based recommendations.
目的
欧洲临床营养与代谢学会于 2018 年发布了儿科肠外营养指南。本研究旨在比较肠外营养（PN）方案与现行指南的差异，评估体重增长情况，并探讨极低出生体重（VLBW）儿在接受 PN 治疗期间，肠外宏量营养素和能量摄入与体重增长结局的相关性。
方法
本研究采用前瞻性观察性研究方法。描述 PN 期间的宏量营养素和能量摄入情况。评估 PN 期间的体重增长情况。采用 Cox 比例风险模型确定 PN 后体重增长结局相关的营养因素。
结果
本研究共纳入 163 例婴儿，其中 41 例为极早产儿（ELBW），122 例为 VLBW 儿。生后第 1 周平均葡萄糖、氨基酸、脂肪和能量摄入量分别为 7.5 g/kg/d、2.4 g/kg/d、0.8 g/kg/d、48 kcal/kg/d。最大葡萄糖、氨基酸、脂肪和能量中位数分别为 11.1 g/kg/d、3.5 g/kg/d、3 g/kg/d、78 kcal/kg/d。最大葡萄糖、氨基酸、脂肪和能量达到时间的中位数分别为 10、9、12、11 天。适合胎龄儿（AGA）的比例为 76.9%。PN 后体重增长不良的婴儿比例为 38%。生后第 1 周最大氨基酸摄入量每降低 0.1 g/kg/d，适当体重增长结局的可能性降低 77.6%；平均脂肪摄入量每降低 0.1 g/kg/d，适当体重增长结局的可能性降低 74.4%。最大葡萄糖和能量达到时间每增加 1 天，适当体重增长结局的可能性分别降低 5.6%和 6.1%。
结论
大多数出生体重<1500 g 的早产儿仍未达到最新推荐的营养目标。这些婴儿 PN 后体重增长不良与肠外宏量营养素和能量摄入不足有关。应根据最新的循证推荐意见改进 PN 策略。
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